My first job in health care was at the Harvard Square Homeless Shelter. Together with other energetic undergrads, I helped raise money to start a clinic inside the shelter.
I thought the homeless people who came to the clinic would immediately gravitate to us and the services we provided. But they didn’t. In fact, I remember one patient, whom I’ll call “Fred,” regarded the clinic with outright suspicion. For the life of me, I couldn’t figure out what we were doing wrong.
Years later, I came to understand that, though we’d built a great facility, what we’d failed to build was trust. Men and women like Fred had been bounced around from one end of the health system to the other, receiving fragmented care from any number of providers who treated the ailments in front of them and then sent them on their way. These anonymous clinicians failed to build trust with Fred. So he viewed them — and the whole health system — with suspicion.
I think about this experience a lot these days. We live in a time when the democratization of information is eroding people’s trust — in one another, in expertise, and in institutions. As my experience in the clinic shows, as physicians, we can’t hope to heal people who don’t trust us.
That’s a problem because trust is fundamentally about longitudinal relationships that are developed over time. And yet, in our fragmented, fee-for-service-based health system, patients often see a multitude of clinicians, with whom they spend very little time. At best, this system undermines continuity of care. At worst, it undermines trust.
So it’s incumbent on us to go against the grain and take meaningful steps toward trust-building. We can build trust by doing what we say we’ll do, by being responsive, by being transparent, and by being authentic.
Sometimes the steps are harder. Sometimes the best way to build trust is to work closely with our patients to get to the root causes of their ailments, whether those causes are health-related, behavioral, economic, or social. It’s easy to write a prescription for an illness. It’s harder to talk to a patient about how they came to contract that illness, or why it might be recurring.
In the years since I worked at the homeless clinic, I’ve made it my priority to take the time to listen to my patients, to answer their questions, and to understand how my actions look from their points of view. As clinicians, we may not always have all the answers, but the least we can do is be present and intentional in our efforts to establish and nurture trust.
That’s not always easy. But as I learned from patients like Fred, it is always necessary.
Sachin H. Jain, MD, MBA, FACP is CEO of SCAN Group and Health Plan and Adjunct Professor of Medicine at Stanford University School of Medicine.